The Nauseating ‘Side Effect’ of Medical Care

As millions of Americans celebrate their newfound status as medically "insured" through the Affordable Care Act, they may still join the ranks of financially strapped patients facing the rising cost of medical services. Fifty-eight percent of Americans reported foregoing or delaying medical care in the past year because, even with insurance, they could not afford the portion of the bill that they were expected to pay. And while many are familiar with the vague concepts of costly prescriptions and expensive tests, the reality can be found in $300 tooth extractions, $200 office visit fees because deductibles had yet to be met, and insured patients who lose their homes attempting to pay the out-of-pocket portion of medical expenses.

The New England Journal of Medicine announced in 2013 that physicians should be obligated to discuss out-of-pocket costs as a "side effect" to treatment when they make decisions about their patients’ care. The journal considered this discussion as imperative to reigning in the costs of care. The concern was that healthcare providers often neglected to discuss potential costs before ordering diagnostic tests, saddling the patient with "daunting and potentially avoidable healthcare bills," wrote journal author Peter A. Ubel, M.D., a professor of business administration and medicine and public policy at Duke University in Durham, N.C.

But how does one choose between receiving necessary tests and care on the front end and dealing with the resulting bill later or possibly exacerbating a condition by not having it firmly examined due to costs? The simple answer is: Get the needed services and suffer the consequences later.

Several years ago while living in a state with average winter temperatures in the minus digits, I found myself laboring for breath and pretty scared about it. Upon arrival at an emergency room, I was told I had to allow them to monitor me for a span of 24 hours and given a room for the night. What would eventually be named and celebrated a "corrective bout of anemia," almost caused a coronary when I received a bill for more than $30,000. The total balance of treatment, which consisted of me taking a stress test (I have the heart of a 20 year old), and lying in an uncomfortable bed watching soap operas overnight, was due within 30 days service – half of which had already expired when the bill was received. As a law-abiding citizen who pays her taxes,votes regularly, and is pretty civic minded, I felt overwhelming embarrassment when a court deputy arrived at my door fifteen days later with a summons to appear in court and the phone number of the law offices handling the lawsuit against me.

While I was happy to be healthy, I could not imagine coming up with $30,000. I was grateful my status as a broke graduate student classified me a "hardship case" with hospital administrators and allowed them to reduce the total to $400 — to be paid in ten increments of $40 each. Others do not fare as well as I did and between hospital, office visit, procedure, and prescription bills, are further sickened by the stress of having to pay these bills. A recent survey found that 45 percent of people receiving prescriptions skipped filling them because of the cost (an increase of 19 percent); and 63 percent put off a doctor’s visit to save money (an increase of 16 percent).

If stress is a major contributor to overall poor health, the costs of care has to be considered as more than a "side effect" when factoring in methods of diagnosis and treatment. This edition of the Informer Health Supplement, Understanding the Financial Literacy of Medical Care, is designed to equip readers with tools necessary to financing their healthcare needs.